Healthcare Provider Details

I. General information

NPI: 1649378233
Provider Name (Legal Business Name): JAMES WARREN HANNA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 W PROSPECT RD
ASHTABULA OH
44004-6623
US

IV. Provider business mailing address

1813 W PROSPECT RD
ASHTABULA OH
44004-6623
US

V. Phone/Fax

Practice location:
  • Phone: 440-998-6235
  • Fax: 440-992-7394
Mailing address:
  • Phone: 440-998-6235
  • Fax: 440-992-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number30-01-5310
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: